title: Mechanical circulatory support with the Impella 5.0 device for postcardiotomy cardiogenic shock: a three-center experience.
abstract: OBJECTIVE
  Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates, despite full conventional treatment. Although the results of treatment with surgically implantable ventricular assist devices have been encouraging, the invasiveness of this treatment limits its applicability. Several less invasive devices have been developed, including the Impella system. The objective of this study was to describe our three-center experience with the Impella 5.0 device in the setting of PCCS.
  
  
  METHODS
  From January 2004 through December 2010, a total of 46 patients were diagnosed with treatment-refractory PCCS and treated with the Impella 5.0 percutaneous left ventricular assist device at three european heart centers. Baseline and follow-up characteristics were collected retrospectively and entered into a dedicated database.
  
  
  RESULTS
  Within the study cohort of 46 patients, mean logistic and additive EuroSCORES were 24 ± 19 and 10 ± 4. The majority of patients underwent coronary artery bypass grafting (48%) or combined surgery (33%). Half of all patients had been treated with an intra-aortic balloon pump before 5.0-implantation, 1 patient had been treated with an Impella 2.5 device. All patients were on mechanical ventilation and intravenous inotropes. The Kaplan-Meier estimate of overall 30-day survival was 39.5%.
  
  
  CONCLUSIONS
  Thirty-day survival rates for patients with PCCS, refractory to aggressive conventional treatment and treated with the Impella 5.0 device, are comparable to those reported in studies evaluating surgically implantable VADs, whereas the Impella system is much less invasive. Therefore, mechanical circulatory support with the Impella 5.0 device is a suitable treatment modality for patients with severe PCCS.
authors.affiliation: AMC Heart Center, Department of Cardiology Academic Medical Center Amsterdam, The Netherlands - a.e.engstrom@amc.uva.nl.
authors.forename: A E
authors.initials: AE
authors.lastname: Engström
authors.forename: H
authors.initials: H
authors.lastname: Granfeldt
authors.forename: W
authors.initials: W
authors.lastname: Seybold-Epting
authors.forename: M
authors.initials: M
authors.lastname: Dahm
authors.forename: R
authors.initials: R
authors.lastname: Cocchieri
authors.forename: A H G
authors.initials: AH
authors.lastname: Driessen
authors.forename: K D
authors.initials: KD
authors.lastname: Sjauw
authors.forename: M M
authors.initials: MM
authors.lastname: Vis
authors.forename: J
authors.initials: J
authors.lastname: Baan
authors.forename: K T
authors.initials: KT
authors.lastname: Koch
authors.forename: M
authors.initials: M
authors.lastname: De Jong
authors.forename: W K
authors.initials: WK
authors.lastname: Lagrand
authors.forename: J A P
authors.initials: JA
authors.lastname: Van Der Sloot
authors.forename: J G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: R J
authors.initials: RJ
authors.lastname: De Winter
authors.forename: B A J M
authors.initials: BA
authors.lastname: De Mol
authors.forename: J J
authors.initials: JJ
authors.lastname: Piek
authors.forename: J P S
authors.initials: JP
authors.lastname: Henriques
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D016208:Databases, Factual; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents